Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor

ICR 202401-1240-007

OMB: 1240-0011

Federal Form Document

Forms and Documents

Document Name	Status
Form CM-972 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form	Modified
Form CM-972 Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form	Modified
SS 1240-0011 CM-972_2023_OCIO MM.docx Supporting Statement A	2024-01-30
SS 1240-0011 CM-972_2023_OCIO MM.docx Supporting Statement A	2024-01-30
Justification CM-972.docx Justification for No Material/Nonsubstantive Change	2024-01-30
Justification CM-972.docx Justification for No Material/Nonsubstantive Change	2024-01-30
DOL-OWCP-2, Office of Workers' Compensation, Black Lung Benefits Claim File.pdf Supplementary Document	2017-02-22
DOL-OWCP-2, Office of Workers' Compensation, Black Lung Benefits Claim File.pdf Supplementary Document	2017-02-22

IC Document Collections

IC ID	Document Title	Status
13877	Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form	Modified
13877	Application for Approval of a Representative's Fee in Black Lung Claim Proceedings Conducted by the U.S. Department of Labor Form	Modified